District Volunteer Application

We appreciate your interest in volunteering for the District Volunteer Program. Our district offers a variety of activities you may choose from when volunteering your time. Simply complete and submit a volunteer application for approval.

It is very important that the information you enter on the application matches your government issued identification card including your full legal name. It is important that you provide a valid email address so you can be notified as to the status of your application and for future communication. If you are unable to provide an email address, you use the district’s email address. All information collected on the application will remain confidential and not be shared outside the volunteer program.

If you have any questions about the application, please request to speak with a volunteer representative.

Thank you,

Owen J. Roberts School District

Personal Information

Legal First Name

Address Line 1

Legal Middle Name

I don't have a middle name

Address Line 2 / Apt # / Building #

Legal Last Name

City

Maiden Name

State/Province/Region

Gender

Postal/Zip Code

Date Of Birth

Phone Number Phone number is required

Affiliation

Preferred Language (for future communications)

Please note: An email will be sent to the email address entered to inform you of the status of your application.

Please select the schools at which you wish to volunteer

Please select the functions from the list below. (select all that apply)

Documents

The following documents are required by the state to authorize clearance within this school district. Please make sure to that all documents have completely uploaded before continuing with application.

Please select the organization(s) on behalf of which you are volunteering (if not applicable, select "None")

Please read the disclaimer below and provide your signature

By providing your signature, you are agreeing to abide by the rules and regulations of the District Volunteer Program, the information below, and Policy 916. Policy 916 can be found on our district website under the School Board heading.

Volunteer Self-Reporting Commitment - By providing your signature, the applicant has never been arrested or convicted of certain offenses, including offenses that would prohibit employment under 23 Pa.C.S.A. § 6344(c) and certain other offenses, has never been named as a perpetrator in a founded or indicated report of child abuse, and if in the future the applicant is arrested or convicted for any such offense or is named as a perpetrator, the individual will provide written notice to the District within 72 hours of such event, which notice will be on the PDE-6004 Form if related to an arrest or conviction.

Volunteer Acknowledgement of Policy No. 916/Volunteers and Policy No. 806/Child Abuse – By providing your signature, the applicant has read, understands, and agrees to comply with the district policies. Without regard to whether an individual meets the definition of Volunteer or Co-op or Similar Program Supervisor, in accordance with School Code § 1418(b) and 28 Pa. Code § 23.44, any individual who provides direct services to students on behalf of the District that involves direct contact with students 10 or more hours per week is also required to:

Receive a tuberculin skin test and provide documentation of the same in accordance with Pennsylvania Department of Health regulations and send the test results to the school secretary.

Receive an updated tuberculin skin test and provide documentation of the same within 5 years from the date of the most recent tuberculin skin test and send the test results to the school secretary.

Name

Signature

By signing your name you agree to all the above statements. Use the mouse or touch screen to sign.

Thank You

Your volunteer application has been successfully submitted and will be reviewed per the district’s volunteer policy. In the near future, you will be notified as to your volunteer status.